Why aren’t vision exams covered by insurance?

Vision Exams in Denver
Mature women on a medical appointment with ophthalmologist

Eye exams are extremely important to eye health. It’s recommended that most adults see an eye doctor every two years, with older adults going for an eye exam annually. Regular eye exams can help with visual acuity and can also diagnose serious eye problems early enough for successful treatment. Why, then, are these exams not covered by health insurance in the United States?

Of course, there is eye insurance available to cover regular exams, but it’s different from your regular health insurance. Since the passage of the Affordable Care Act (ACA) vision insurance has been phased into the health care marketplace, but because oral and vision care aren’t considered essential health services, these policies are offered separately from a person’s health care plan. The ACA does require pediatric health insurance to cover vision and dental care. Why is dental and eye insurance priced separately? It has to do with the different types of the eye doctors.

Optometrists are eye doctors who examine, diagnose, and treat your eyes, as well as prescribe contacts and eyeglasses. Ophthalmologists, on the other hand, are medical doctors who treat eye conditions through medical and surgical interventions. Typically, medical insurance covers treatment by an ophthalmologist, which is considered specialty care. Visits to the optometrist, on the other hand, are not covered.

Unfortunately, many serious eye conditions have no symptoms, and without regular eye exams, they may go undetected until it’s too late for effective treatment. An optometrist provides tests to determine whether a patient has these conditions, but how will patients with no access to regular eye exams know when to get a test? About 50 percent of people in the United States don’t have vision coverage, even though 93 percent of those same people believe vision coverage benefits are important. When they want to see an eye doctor, half of Americans have to pay for those expenses out of pocket. Even Medicare doesn’t cover routine eye exams, though it does cover some screenings, and many eye doctors don’t accept Medicaid.

There are online tools for self-diagnosis, but they’re not very effective. These free online tests can help determine your visual acuity and even make you aware of some serious eye conditions, but only in-person tests and exams can determine whether you have conditions like cataracts or glaucoma. This is also why telehealth services aren’t a good choice for eye exams. There’s no substitute for regular in-person eye exams.

If you’re concerned about the cost of an eye exam, there are some resources available to you. The National Eye Institute has a list of resources for eye care, glasses, and even surgeries. The AOA Foundation has a state-specific list, EyeCare America provides free exams, and Lion’s Club International provides vision screening.

If you need an eye exam, Denver Eye Surgeons offers a variety of payment options. In addition to accepting many different insurance plans, we also offer in-office financing through CareCredit and Unicorn Financial. Our premier multi-specialty vision care practice in Denver, Colorado, Denver Eye Surgeons provides a wide range of eye care services, delivering the best care in a friendly environment. We offer comprehensive eye exams to help keep your vision healthy, as well as advanced eye care services, using the most innovative treatments in procedures performed by experienced medical professionals. Our community-focused practice has the best doctors and the best staff, all here to meet the needs of you and your family. Call 303.279.6600 or visit our website to contact us today!

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